Provider Demographics
NPI:1396962932
Name:REYNOLDS, DEBRA SUE (MA)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:SUE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:SUE
Other - Last Name:HUNTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:3240 SW TARA AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66611-2437
Mailing Address - Country:US
Mailing Address - Phone:785-230-4636
Mailing Address - Fax:
Practice Address - Street 1:3240 SW TARA AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66611-2437
Practice Address - Country:US
Practice Address - Phone:785-230-4636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1092235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1092OtherSTATE LICENSE